Literature asserts that prenatal
care is an imperative factor for subsequent health care utilization. However,
in the Indian settings presence of selection bias while determining the impact of
ANC visits on institutional delivery has been overlooked by the researchers. Therefore
this paper aims to examine the net impact of ANC visits on subsequent utilization
of institutional delivery after removing the presence of selection bias using
recent round of National Family Health survey data. The analysis has been carried
out in two separate models, in the first model 1-2 ANC visits been compared with
no visit and in the second model three or more antenatal care visits with no visit.
The propensity score matching analysis used in this study sheds new light into this
line of research which provides an effective strategy for controlling the confounding
influence of institutional delivery. Employing the propensity score matching estimation approach we found women who made 1-2 ANC visits had 6.6 percent higher
chance to deliver in an institution compared to women who made no visit. In addition,
if a woman visited health centre three or more than three times, her chances were
31 percent higher to deliver in an institution. Result based on sensitivity analysis
suggests that selection bias on unobserved covariates would have to be around 40
percent to alter the impact of 1-2 ANC visits. Findings suggest that interventions
which plan to increase institutional delivery should target pregnant women who
come for ANC checkups at institution first time, and health workers should encourage women to return to the health centre for more numbers of
visits, as our results indicate that three or more ANC visits significantly change
the women’s attitudes towards institutional delivery.

Sugathan, K.S., Mishra. V. and Retherford, R.D. (2001) Promoting institutional delivery in India: Role of antenatal care services. National family health survey. Subject Report, International Institute for Population Sciences and East West Centre, Honolulu.

Mishra, V. and Retherfort, R.D. (2006) The effect of antenatal care on professional assistance at delivery in rural India. Demographic and Health Research, 28.
http://www.measuredhs.com/pubs/pdf/WP28/WP28.pdf

Mishra, V. and Retherfort, R.D. (2008) The effect of antenatal care on professional assistance at delivery in rural India. Population Research and Policy Review, 27, 307- 320. doi:10.1007/s11113-007-9064-3

Zerai, A. and Tsui, A.O. (2001) The relationship between prenatal care and subsequent modern contraceptive use in Bolivia, Egypt and Thailand. The African Journal of Reproductive Health, 5, 68-82. doi:10.2307/3583432